The NIH Needs To Increase Efforts To Fight Drug Resistant Bacteria

While the emergence of bacteria that are resistant to current antibiotics has long been a topic of discussion, a new report from the UK has heightened concerns. The “Review on Antimicrobial Resistance” resulted from a project initiated by UK Prime Minister David Cameron and financed by the Wellcome Trust. As summarized by Maryn McKenna in her “Germination” blog, the review provides pretty alarming statistics. The global toll due to resistance is roughly 700,000 deaths per year. Even worse, this is projected to grow to 10 MILLION deaths per year if nothing is done to reverse this trend.

The UK review makes a number of suggestions on how to better cope with resistant bugs. These include better hygiene, more judicious use of existing drugs, greater use of vaccines, better diagnostic tools and better economic incentives to foster research into new drugs. The latter is a key issue. While some major companies like GSK and
AstraZeneca remain committed, others like
Pfizer have gotten out of antibiotic R&D because any new drug would be put on the shelf to be used only as a last resort should all other antibiotics fail. Such a strategy is necessary to minimize antibacterial resistance to the new drug. But the economic rewards that one might hope for with a new breakthrough are severely lessened in such a scenario.

Let’s envision, however, that a system can be worked out where appropriate incentives are put in place. There still remains the major issue in the search for new effective antibiotics–new targets against the emerging drug-resistant bacteria. Biopharmaceutical industry R&D, for the most part, is applied research; that is, it studies the basic science that emerges from academic labs and research institutes and looks to find potential drugs that prove or disprove the medical hypotheses that are produced by these academic efforts. These basic research efforts are funded predominantly by the
National Institutes of Health (NIH). In effect, the priorities set by the NIH dictate those therapeutic areas that scientists focus on. The NIH’s influence is substantial: in 2015, it allocated its $30.4 billion budget across 265 research and disease areas.

The National Institute of Allergy and Infectious Diseases (NIAID) is that section of the NIH responsible for infectious diseases. In 2015, its budget was almost $4.4 billion, one of the biggest budgets of any of the Institutes that comprise the NIH. While this shows the importance that the NIH and the U.S. puts on this area of research, the remit of the NIAID is very broad and includes funding programs in: AIDS, TB, Ebola, biodefense, MERS, etc. Amid all of these priorities, research into antimicrobial resistance seems to be getting squeezed out, with only $310 million spent in 2015. It’s hard to argue against spending money on AIDS, Ebola and the newly emerging Zika virus. But given the looming crisis with drug-resistant organisms, shouldn’t a greater emphasis be put on funding more work into understanding how bacteria are learning to evade current drugs?

The NIH sets the agenda for research priorities in the U.S. By increasing, perhaps even doubling, the funds it allots to antimicrobial resistance, it could provide a big stimulus to the fight against the “antibiotic apocalypse.” It is a step it needs to take.